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Published on: October 3, 2018
Heart rate and early progression of cardiac allograft vasculopathy: A prospective study using highly automated 3-D
Michal Pazdernik1,2, Dan Wichterle1,3, Zhi Chen4
1Department of Cardiology, IKEM, Prague, Czech Republic.
Insights
Higher heart rate did not accelerate cardiac allograft vasculopathy (CAV) in heart transplant (HTx) patients. Beta-blockers may offer protection against early CAV development, warranting further research into their role in HTx recipients.
Area of Science:
- Cardiology
- Transplant Medicine
- Immunology
Background:
- Heart rate slowing agents are commonly used in heart transplant (HTx) patients.
- This practice is based on the assumption that elevated heart rate is a cardiovascular risk factor.
Purpose of the Study:
- To investigate the early progression of cardiac allograft vasculopathy (CAV) in HTx patients.
- To determine the relationship between heart rate and CAV progression in the first year post-transplant.
Main Methods:
- Prospective, two-center study of 116 HTx patients.
- Coronary optical coherence tomography and 24-hour ambulatory ECG monitoring at baseline and 12 months post-HTx.
Main Results:
- Significant reduction in coronary luminal area and progression of intimal thickness (IT) observed within the first year.
- No significant association found between mean heart rates and IT progression.
- A mild inverse association between beta-blocker dosage and IT progression was noted.
Conclusions:
- The study did not confirm a direct link between mean heart rate and CAV progression.
- Beta-blockers may have a protective effect on early CAV development.
- Further investigation into the role of beta-blockers in HTx patients is warranted.
Introduction:
Heart rate slowing agents are frequently prescribed to manage heart transplant (HTx) patients with the assumption that higher heart rate is a risk factor in cardiovascular disease.
Patients And Methods:
This prospective two-center study investigated early progression of cardiac allograft vasculopathy (CAV) in 116 HTx patients. Examinations by coronary optical coherence tomography and 24-hour ambulatory ECG monitoring were performed both at baseline (1 month after HTx) and during follow-up (12 months after HTx).
Results:
During the first post-HTx year, we observed a significant reduction in the mean coronary luminal area from 9.0 ± 2.5 to 8.0 ± 2.4 mm2 (P < .001), and progression in mean intimal thickness (IT) from 106.5 ± 40.4 to 130.1 ± 53.0 µm (P < .001). No significant relationship was observed between baseline and follow-up mean heart rates and IT progression (R = .02, P = .83; R = -.13, P = .18). We found a mild inverse association between beta-blocker dosage at 12 months and IT progression (R = -.20, P = .035).
Conclusion:
Our study did not confirm a direct association between mean heart rate and progression of CAV. The role of beta blockers warrants further investigation, with our results indicating that they may play a protective role in early CAV development.
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